Navegando por Palavras-chave "Endophthalmitis"
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- ItemAcesso aberto (Open Access)Avaliação clínica e incidência de endoftalmite infecciosa e não-infecciosa após injeção intravítrea de acetonida de triancinolona(Conselho Brasileiro de Oftalmologia, 2006-12-01) Magalhães, Érika; Nehemy, Patrícia; Santos, Daniel Vítor De Vasconcelos; Fujji, Gildo [UNIFESP]; Nehemy, Márcio Bittar; Universidade Federal de Minas Gerais Faculdade de Medicina; UFMG; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of 4 mg of triamcinolone acetonide (Kenalog® - 40 mg/ml; 0.1 ml) and to evaluate distinguishing characteristics that may assist the clinician in differentiating these entities. Design: Observational nonconcurrent prospective study. METHODS: Charts of 121 patients (154 injections) who consecutively underwent intravitreal injection of triamcinolone acetonide to treat various chorioretinal diseases were evaluated. All procedures were performed in an operating room with careful antiseptic protocol. RESULTS: Two eyes (1.29%/injection and 1.65%/patient) presented a noninfectious endophthalmitis characterized by decreased vision, hyperemia, hypopyon and vitreous inflammatory reaction, on the first day after the injection. These eyes were treated with topical and subconjunctival corticosteroids with complete resolution of the inflammatory reaction. CONCLUSION: In the present case series, no case of infectious endophthalmitis occurred. Despite being relatively rare, noninfectious endophthalmitis can be associated with intravitreal injection of triamcinolone simulating an infectious endophthalmitis. In selected cases, the differential diagnosis can be made solely by clinical evaluation.
- ItemAcesso aberto (Open Access)Contaminação de halos doadores córneo-esclerais em ceratoplastia penetrante no Hospital de Clínicas de Porto Alegre(Conselho Brasileiro de Oftalmologia, 2008-02-01) Borowsky, Cláudia Martins; Wallau, Anelise Dutra [UNIFESP]; Reetz, Aline; Kwitko, Sérgio [UNIFESP]; Rymer, Samuel; Locatelli, Claudete Inês; Universidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto Alegre; Universidade Federal de São Paulo (UNIFESP); Universidade de Passo Fundo; Hospital de Clínicas de Porto Alegre; UFRGS Faculdade de Medicina; UFRGS Hospital de Clínicas de Porto Alegre; UFRGSPURPOSE: To determine the incidence of positive corneoscleral rim cultures preserved in Optisol GS medium, to identify pathogens involved and possible recipient eye infection. METHODS: A hundred sixty-three corneoscleral rim cultures penetrating keratoplasties performed from January 2001 to January 2003 in the Hospital de Clínicas de Porto Alegre were reviewed. Enucleations and corneal storage were done as aseptic as possible and gentamicin 0.3% was instilled. Corneoscleral rim was divided into two segments, half was inoculated into Sabouraud broth and the other half into thioglycolate broth; inoculation into blood agar, chocolate agar and MacConkey agar was done later if necessary for pathogen identification. The receiver's eye data were reviewed. RESULTS: There were eleven positive cultures (6.7%) out of 163 evaluated corneoscleral rim cultures. Of these, four were Staphylococcus epidermidis, one was Staphylococcus aureus, one was Serratia sp., one was Pseudomonas aeruginosa and the other four were different subtypes of Candida (two Candida sp., one Candida albicans and one Candida parapapilosis). All pathogens were resistant to gentamicin. None of the eleven cases of positive corneoscleral rim cultures resulted in ocular infection at the receiver's eyes (six months follow-up). CONCLUSIONS: We found low rates of positive corneoscleral rim cultures after penetrating keratoplasty at the Porto Alegre Clinical Hospital. The most frequent involved pathogens were Staphylococcus sp and Candida sp. Although we did not identify any postoperative infection at the receiver's eyes, we recommend corneoscleral rim culture for guidance of postoperative infection, a rare but possible devastating ocular event.
- ItemAcesso aberto (Open Access)Efeito terapêutico da aplicação intra-ocular de ozônio em modelo experimental de endoftalmite por Staphylococcus epidermidis em coelhos(Conselho Brasileiro de Oftalmologia, 2004-08-01) Lake, Jonathan Clive; Felberg, Sergio; Malavazzi, Gustavo Ricci [UNIFESP]; Goulart, Denise Atique [UNIFESP]; Nishiwaki-dantas, Maria Cristina; Dantas, Paulo Elias Correa; Santa Casa Departamento de Oftalmologia Seção de Córnea e Doenças Externas; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the anti-inflammatory and antimicrobial effect of intraocular ozone diluted in BSS on experimental Staphylococcus epidermidis endophthalmitis. METHODS: We injected 0.1ml of S. epidermidis colonies (10(5) colonies/ml) to produce experimental endophthalmitis in the right eyes of 17 New Zealand rabbits. Seven rabbits were assigned to a control group and received an intravitreal injection of 0.1ml BSS. Ten rabbits were treated with intravitreal injection of 0.1ml BSS-diluted ozone (2 ppm). Data were distributed according to clinical and histological findings after 24 hours, each rabbit receiving a score. Mean scores and standard deviations were compared using the two-sample t test. RESULTS: Mean clinical score for the control group was 11.14 ± 1.04. Mean clinical score for the treated group was 4.90 ± 1.29, which was significantly lower (p<0.01). Mean histological scores were, respectively, 17.00+ 0.57 and 10.20 ±1.30 for the control group and the treated group. The histological scores were significantly lower for the treated group (p<0.01). All cultures in both control and ozone groups were positive after 24 hours of experiment. CONCLUSION: Treatment with diluted ozone significantly reduced the inflammatory reaction in our model of experimental endophthalmitis. This probably occurred due to a decrease in bacterial content after ozone injection. It is necessary to study other ozone concentrations in different experimental models in order to determine ozone efficacy with a higher precision.
- ItemAcesso aberto (Open Access)Eficácia de um regime de administração de antibióticos tópicos na redução da microbiota conjuntival de pacientes sadios com catarata senil(Sociedade Brasileira de Oftalmologia, 2007-08-01) Oliveira, Renato Corrêa Souza De [UNIFESP]; Brasil, Oswaldo Ferreira Moura [UNIFESP]; Arantes, Rodrigo Setúbal; Caldas, Leomar Afonso Da Silva; Ferreira, Adriana Lucia Íris; Moraes Junior, Haroldo Vieira De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Brasileiro de Oftalmologia Médico do Setor de Retina e Vítreo; Universidade Federal do Rio de Janeiro; Universidade Federal do Rio de Janeiro Hospital Universitário Clementino Fraga Filho Laboratório de Bacteriologia ClínicaPURPOSE: To evaluate the conjunctival bacterial flora of healthy patients and its antibiotic resistance pattern and determine the effective of a regime of topical antibiotics on reduction of endogenous microbiota. METHODS: Its a prospective non randomized study. Fourty eyes of 40 patients, divided in 4 groups of 10 eyes each, used four differents topical antibiotics (ciprofloxacin, tobramycin and gatifloxacin). One group served as a control group. Were performed conjunctival cultures before instillation of the antibiotics drops and after 15, 30 and 60 minutes. Were performed susceptibility tests of the specimes isolated to these antibiotics. We compared the reduction of bacterium growth by assessing the number of UFC (colonies forming units) before and after the instillation of antibiotics drops. RESULTS: Of the 40 eyes, 92,5% had positive cultures. The coagulase-negative Staphylococcus (CNS) was the most frequent organism isolated (50%), followed by Staphylococcus Aureus (23%) and gram-negative bacteria (26%). More than 81% of the isolates of this bacterium were susceptible to all antibiotics tested. Five bacterium isolates were resistant to ciprofloxacin and tobramycin and two to gatifloxacin. All groups had diminished the number of patients with positive culture specimes from the conjuntiva compared to moment zero and to placebo. CONCLUSION: The gram positive bacterium, specially the coagulase-negative Staphylococcus, were the most frequent microorganism found on conjunctiva of healthy patients. The most of the bacterium isolated were sensitivity to the antibiotics tested. The proposed regime of use of these antibiotics reduced the number of UFC (colonies forming units) compared to placebo although without statics relevance in most of cases.
- ItemAcesso aberto (Open Access)Endoftalmite por Candida albicans após transplante penetrante de córnea: relato de caso(Conselho Brasileiro de Oftalmologia, 2004-04-01) Godoy, Glaucio De; Wahab, Sâmia Ali; Hofling-Lima, Ana Luisa [UNIFESP]; Moreira, Hamilton [UNIFESP]; Hospital de Olhos do Paraná; Instituto de Pesquisas Médicas; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Paraná; Faculdade Evangélica do ParanáThe authors report a case of a patient submitted to penetrating corneal graft for keratoconus with an exaggerated inflammatory response during the postoperative period. The patient was suspected of having an atypical rejection to the donor button. There were periods of improvement, followed by periods of worsening of the inflammation at each attempt of reducing the topical corticosteroid. After initiating immunosuppressive therapy with cyclosporin and high doses of topical corticosteroid, the patient developed Candida albicans endophthalmitis affecting the anterior segment of the eye and the vitreous body, but sparing the chorioretina. The patient improved after three injections of 5 µg intravitreal amphotericin B, 400 mg oral ketoconazole daily and topical clotrimazole every four hours. The authors also discuss the main possibilities of contamination of the patient, the infectious picture probably being related to the surgical procedure.
- ItemAcesso aberto (Open Access)Endoftalmites bacterianas com culturas positivas: uma revisão de 6 anos(Conselho Brasileiro de Oftalmologia, 2008-10-01) Bispo, Paulo José Martins [UNIFESP]; Melo, Gustavo Barreto de [UNIFESP]; D'azevedo, Pedro Alves; Hofling-Lima, Ana Luisa [UNIFESP]; Yu, Maria Cecília Zorat [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Fundação Faculdade Federal de Ciências Médicas de Porto Alegre - FFFCMPA Departamento de Microbiologia e ParasitologiaPURPOSE: To assess the distribution of microorganisms isolated from patients with bacterial endophthalmitis and their antimicrobial susceptibility. METHODS: Retrospective analysis of medical and microbiological records of patients with suspected diagnosis of endophthalmitis and bacterial culture-proven at the Department of Ophthalmology, UNIFESP, between January 1 2000 and December 31 2005. RESULTS: 153 (33.9%) of 451 patients showed positive bacterial culture. A total of 155 microorganisms were isolated, 79.35% were gram-positive and 20.65% gram-negative. Staphylococcus (CoNS) (41.94%) were the most frequently isolated. The antimicrobial susceptibility for gram-negative microorganisms was as follows: amikacin 87.10%, tobramycin 80.65%, ciprofloxacin 96.67%, levofloxacin, gatifloxacin and moxifloxacin 100%, ceftazidime 85.0%, and gentamicin 80.65%. Vancomycin sensitivity among gram-positive microorganisms was 100%. S. aureus and CoNS showed 83.33% of susceptibility to oxacillin, 89.61% to ciprofloxacin and 100% to gatifloxacin and moxifloxacin. The main acquisition mechanism was postoperative (60.65%). CONCLUSION: We detected a low sensitivity of vitreous/aqueous culture for the etiologic diagnosis of endophthalmitis. The empiric antimicrobial therapy or prophylaxis should be active against gram-positive bacteria, particularly staphylococci. Surveillance studies of bacterial resistance are important for a better utilization of antimicrobials in this clinical setting.
- ItemAcesso aberto (Open Access)Flora bacteriana conjuntival após uso tópico de ciprofloxacino e gatifloxacino em cirurgia de catarata(Conselho Brasileiro de Oftalmologia, 2008-04-01) Arantes, Tiago Eugênio Faria e [UNIFESP]; Castro, Célia Maria Machado Barbosa de; Cavalcanti, Ronald Fonseca; Severo, Maiara Santos; Diniz, Maria de Fátima Alves; Urtiga, Ricardo Walber de Deus; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Pernambuco Departamento de Medicina Tropical; Fundação Altino Ventura Departamento de Córnea e Doenças Externas; UFPE Laboratório de Imunopatologia Keizo-Asami; FAVPURPOSE: To evaluate alterations of the conjunctival flora after the use of 0.3% ciprofloxacin and gatifloxacin in the prophylaxis of patients undergoing cataract surgery. METHODS: 40 patients undergoing cataract surgery were distributed into two groups according to the use of antibiotic eye drops: Group A: 0.3% ciprofloxacin and Group B: 0.3% gatifloxacin. Both groups used antibiotic eye drops 1 hour before surgery and 14 days after surgery. Conjunctival material was collected at 5 time points: 1 hour before surgery, without any topical medication (t0); immediately before the application of povidone-iodine (PVPI) (t1), before the beginning of surgery, after povidone-iodine (t2), 14 days (t3) and 28 days after surgery (t4). RESULTS: Preoperative antibiotics reduced the positivity of the cultures before the use of PVPI in both groups, although in Group A this reduction was not significant (Group A - p=0.07 and Group B - p=0.04). The number of positive cultures was reduced in all groups after the use of povidone-iodine and on the 14th postoperative day (p<0.05). In t4 there was a reduction in the frequency of coagulase-negative Staphylococcus in Group A compared with Group B (p<0.05); the susceptibility to ciprofloxacin was also reduced in all groups, when compared with t0. CONCLUSIONS: Gatifloxacin eye drops applied one hour before surgery significantly reduced the number of positive conjunctival cultures. Both antibiotics reduced the conjunctival flora when administered in the postoperative period.
- ItemAcesso aberto (Open Access)Incidence of endophthalmitis after cataract surgery (2002-2008) at a Brazilian university-hospital(Conselho Brasileiro de Oftalmologia, 2010-12-01) Melo, Gustavo Barreto de [UNIFESP]; Bispo, Paulo José Martins [UNIFESP]; Regatieri, Caio Vinicius Saito [UNIFESP]; Yu, Maria Cecília Zorat [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Hofling-Lima, Ana Luisa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To report on the incidence, diagnostic technique, and microbiological features of endophthalmitis at a university-setting in Brazil. Methods: All cases of presumed postoperative endophthalmitis from 2002 to 2008 at a teaching-hospital were included. Main data assessed were: number of cataract surgeries performed, incidence of endophthalmitis, microbiological outcome (aqueous and/or vitreous culture and Gram staining), and antimicrobial susceptibility testing of the positive cases. Results: Seventy-three eyes of 73 patients (43 females and 30 males) developed endophthalmitis after 24,590 cataract surgeries. The incidence decreased from 0.49% in 2003 to 0.17% in 2006 and stabilized afterwards. Coagulase negative Staphylococci (CoNS) and Streptococcus viridans (56.5% and 15%, respectively) were the most common bacterial isolates. Culture and Gram stain were negative in 36.9%. CoNS presented susceptibility rates of 80%-sensitivity to oxacillin, 90% to fourth-generation quinolones and 100% to vancomycin. Conclusions: The rate of endophthalmitis, diagnostic ability of conventional laboratory investigation, microbial isolates and antibiotic susceptibility are in accordance with other findings of the literature. Despite using prophylactic antibiotic drops, it was possible to identify cases that were susceptible to the antibiotics topically applied.
- ItemAcesso aberto (Open Access)Minimizando erros na administração de drogas intravítreas(Conselho Brasileiro de Oftalmologia, 2003-01-01) Yeh, Shu I [UNIFESP]; Branco, Bruno Castelo; Yasaki, Érika Sayuri [UNIFESP]; Schor, Paulo [UNIFESP]; Freitas, Denise de [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Paulista de Estudos e Pesquisas em OftalmologiaPURPOSE: To assess evaluate the accuracy of intravitreal drug administration in the treatment of endophthalmitis and to suggest a reproducible and accessible technique for this procedure. METHODS: To assess the retained volumes in needles used for the intravitreal injection of antibiotics using an analytical scale. RESULTS: Means and standard deviations of retained volumes in the 26, 22 ( 25 x 0.7 mm and 30 x 0.7 mm ) and 18 G were respectively 0.051±0.006, 0.056±0.005, 0.055±0.004 and 0.075±0.004 for needles Ryncos® and 0.050±0.003, 0.056±0.002, 0.063±0.002 and 0.084±0.004 for Becton-Dickinson®. There were statistically significant differences in the retained volumes between the two needle brands for 26, 22 (30 x 0.7 mm) and 18 G needles with p = 0.01, p < 0.01 and p < 0.01 respectively. No difference was found only for 25 x 0.7 mm 22 G needle with p = 0.83. CONCLUSION: Most needles used for intravitreal injection hold a retained volume in the reserve needle compartment that should be considered during the injection technique, therefore minimizing errors during intravitreal injection of antibiotics.
- ItemAcesso aberto (Open Access)Molecular biology applied to the laboratory diagnosis of bacterial endophthalmitis(Conselho Brasileiro de Oftalmologia, 2009-10-01) Bispo, Paulo José Martins [UNIFESP]; Hofling-Lima, Ana Luisa [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Bacterial endophthalmitis is a serious but uncommon intraocular infection which frequently results in vision loss. Early diagnosis and appropriate therapy are associated with better visual outcome. Conventional microbiological methods are currently used for microbiological characterization of eyes with suspected endophthalmitis. However, the sensitivity of bacterial detection from aqueous and vitreous humor using microbiology techniques is poor, and time-consuming to confirm the results. The application of molecular methods enhances significantly laboratory confirmation of bacterial endophthalmitis, demanding a shorter time to draw a definitive result and thereby promoting the early initiation of a more specific therapy to limit the empirical or unnecessary use of broad-spectrum antibiotics. PCR-based techniques, including post-PCR methods such RFLP, DNA probe hybridization and DNA sequencing have been successfully used for the diagnostic elucidation of clinically suspected bacterial endophthalmitis cases, showing promising application in the routine practice of ocular microbiology laboratories.
- ItemAcesso aberto (Open Access)Prevalence and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus in ocular infections(Conselho Brasileiro de Oftalmologia, 2013-12-01) Vola, Maria Eugenia [UNIFESP]; Moriyama, Aline Silveira [UNIFESP]; Lisboa, Renato [UNIFESP]; Vola, Maria Magdalena; Hirai, Flávio Eduardo [UNIFESP]; Bispo, Paulo José Martins [UNIFESP]; Hofling-Lima, Ana Luisa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidad de la República Facultad de Medicina Instituto de HigienePURPOSE: To study the prevalence of methicillin-resistant Staphylococcus aureus among S. aureus ocular infections in a tertiary health center in Brazil and compare antibiotic susceptibility patterns between MRSA and methicillin-susceptible S. aureus isolates. METHODS: Electronic records from the ocular microbiology laboratory of the Universidade Federal de São Paulo (UNIFESP) were retrospectively reviewed. During a 10-year period (between January 2000 and December 2009) all conjunctivitis, keratitis, and endophthalmitis cases with a positive culture for S. aureus were identified. Antibiotic susceptibility was determined using the Kirby-Bauer disk diffusion method. RESULTS: Five hundred sixty-six S. aureus isolates were identified; of those, 56 (9.9%) were resistant to methicillin. Throughout the 10-year period, Staphylococcus aureus showed a significant increasing trend from 7.55% to 16.18% among overall S. aurues infections (p=0.001) and from 3.7% to 13.16% in conjunctivitis (p=0.001). Conversely, we did not observe the same trend among those with keratitis (p=0.38). Staphylococcus aureus isolates showed higher resistance rates to tobramycin, gentamicin, ciprofloxacin, gatifloxacin, and moxifloxacin when compared with S. aureus isolates (p< 0.001). All cases were susceptible to vancomycin. CONCLUSION: We observed an increasing trend in the overall prevalence of Staphylococcus aureus ocular infections and statistically significant higher resistance rates to commonly used antibiotics compared to Staphylococcus aureus. Our data supports the need for constant bacterial surveillance and should be taken into consideration before initiating empiric treatment of ocular infections.
- ItemAcesso aberto (Open Access)Safety and efficacy of intracameral moxifloxacin injection for prophylaxis of endophthalmitis after phacoemulsification(Consel Brasil Oftalmologia, 2017) Vieira, Ibraim Viana [UNIFESP]; Boianovsky, Celso; Saraiva, Thais Jones; de Godoy, Rodolfo Bregion; Lake, JonathanPurpose: To evaluate the safety and efficacy of 0.05 mL intracameral injection of moxifloxacin in patients who underwent phacoemulsification and intraocular lens (IOL) implant. Methods: Retrospective study comprising patients who underwent phacoemulsification and IOL implant between January 2009 and December 2013. Patients were divided into two groups. Group A followed standard endophthalmitis prevention protocol and group B followed the same protocol plus intracameral injection of 0.05 mL of moxifloxacin hydrochloride at 5.45 mg/mL, immediately after IOL implant. Results: Medical records from 7,195 eyes of 3,751 patients (median age: 67.8 +/- 8.96, range: 48-83 years, 53.8% female) were evaluated. Group A included 3,515 eyes of 1,838 patients and group B included 3,680 eyes of 1,913 patients. The incidence of endophthalmitis in group A was 0.22% (8: 3,515 eyes) and in group B was 0.03% (1: 3,680 eyes, p= 0.0198, Fischer's exact test). No toxicity or inflammation related to the use of moxifloxacin was observed. Conclusions: There was a 7.3-fold lower ratio of endophthalmitis in the group that received moxifloxacin intracameral injection. This study provides further evidence that moxifloxacin is an effective intracameral prophylactic antibiotic.
- ItemAcesso aberto (Open Access)Ultra-sonografia ocular em suspeita clínica de endoftalmite(Conselho Brasileiro de Oftalmologia, 2001-10-01) Adan, Consuelo Bueno Diniz [UNIFESP]; Blay, Doris [UNIFESP]; Yu, Maria Cecília Zorat [UNIFESP]; Freitas, Denise de [UNIFESP]; Allemann, Norma [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To determine ultrasonographic findings in patients with clinical diagnosis of endophthalmitis, a severe purulent inflammatory reaction confined to the interior of the eye. Methods: Ultrasound examination was performed (10MHz transducer, UltraScan® ALCON), during the period of 1997 to 1999. Results: We analyzed 25 eyes with a clinical diagnosis of endophthalmitis (23 exogenous, 2 endogenous). Twelve (12/23) were post-surgery (7 post-cataract surgery, 4 post-glaucoma surgery and 1 post-keratoplasty). Six followed penetrating trauma and 4 were after corneal ulcer. One patient had corneal suture and cataract surgery after penetrating trauma. Two of them presented low-reflectivity echoes, similar to the normal vitreous, and endophthalmitis was ruled out at that time. Twenty-three cases presented (at different degrees) vitreous involvement with low-mobility dense membranes, vitreous organization and vitreous cavitation. Diffuse choroidal thickening (12 cases), choroidal and/or retinal detachment (8 and 5 cases) and orbital abscess (1 case) were found. Conclusions: Ultrasound examination is important to help in clinical suspected endophthalmitis in order to determine the involvement of the posterior segment.